scholarly journals Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for chronic ankle instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0054
Author(s):  
Yunfeng Zhou ◽  
Bin Song
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomical Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Aofas Score ◽  
Anterior Translation ◽  
Talar Tilt ◽  
American Orthopaedic

Category: Arthroscopy Introduction/Purpose: To evaluate the clinical results of an anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament under arthroscopy in treatment of chronic ankle instability. Methods From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Methods: From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Results: The operations were lasted for 75.8 minutes(72~104 minutes). 28 cases were received a mean follow up of 14.8 months(range, 12~25 months. The mean VAS pain score decreased from 5.79 to 1.54(t=26.63, P<0.01), and the medial AOFAS score improved from 63.64 to 90.21(t=-16.57, P<0.01). Imageological examination were completed 16.8 months after the operation (range, 12~25 months). The mean talar tilt decreased from 15.6°to 6.01°(t=25.39, P<0.01),and anterior translation of the talar reduced from a mean of 10.82 to 4.03 mm(t=15.79, P<0.01). Conclusion: Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament could improve the function and stability of ankle joints effectively, providing a valid option for treating chronic ankle instability.

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

2021 ◽  
pp. 107110072199707
Author(s):  
Yasunari Ikuta ◽  
Tomoyuki Nakasa ◽  
Junichi Sumii ◽  
Akinori Nekomoto ◽  
Nobuo Adachi
Keyword(s):  
Ankle Instability ◽  
Ct Images ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Mri Findings ◽  
Calcaneofibular Ligament ◽  
Level Of Evidence ◽  
Strong Negative Correlation

Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = −0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level of Evidence: Level III. case-control study.

Lower Signal Intensity of the Anterior Talofibular Ligament is Associated with a Higher Rate of Return to Sport After ATFL Repair for Chronic Lateral Ankle Instability

2019 ◽  
Vol 47 (10) ◽  
pp. 2380-2385 ◽  
Author(s):  
Hong Li ◽  
Yinghui Hua ◽  
Sijia Feng ◽  
Hongyun Li ◽  
Shiyi Chen
Keyword(s):  
Signal Intensity ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Return To Sport ◽  
Rate Of Return ◽  
Anterior Talofibular Ligament ◽  
Aofas Score ◽  
Significant Difference ◽  
The Mean

Background: The treatment strategy for anterior talofibular ligament (ATFL) injury is usually determined by the ATFL remnant condition during surgery. Preoperative magnetic resonance imaging (MRI)–based signal intensity of the ATFL remnant, represented by the signal/noise ratio (SNR) value, can reveal the ATFL remnant condition. Thus far, there is a lack of evidence regarding the relationship between the ATFL remnant condition and functional outcomes. Purpose/Hypothesis: The purpose was to quantitatively evaluate whether the MRI-based ATFL ligament SNR value is related to functional outcomes after ATFL repair for ankles with chronic lateral ankle instability. The hypothesis was that a lower preoperative SNR is related to a better clinical outcome, particularly a higher rate of return to sport. Study Design: Cohort study; Level of evidence, 3. Methods: First, a preliminary study was performed to measure the ATFL SNR in preoperative MRI, the results of which suggested that a preoperative SNR >10.4 was indicative of a poor ATFL condition. Then, a cohort study was retrospectively performed with consecutive patients who underwent open repair of ATFL injuries between January 2009 and August 2014. Accordingly, the patients were divided into 2 groups: high SNR (HSNR; ≥10.4) and low SNR (LSNR; <10.4). Functional outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner Activity Scale were then compared between the HSNR group and the LSNR group. Results: Ultimately, 70 patients were available for the final follow-up: 37 in the HSNR group and 33 in the LSNR group. No significant difference was detected between the HSNR group and the LSNR group in terms of the AOFAS score, KAFS, or Tegner Activity Scale ( P > .05 for all) preoperatively. At the final follow-up, the mean ± SD AOFAS score in the LSNR group (92 ± 6) was higher than that in the HSNR group (87 ± 12), although no significant difference was detected postoperatively ( P = .16). The mean KAFS in the LSNR group (94 ± 7) was significantly higher than that in the HSNR group (88 ± 11) postoperatively ( P = .03). At follow-up, the mean Tegner score in the LSNR group (6; range, 3-7) was significantly higher than that in the HSNR group (5; range, 1-8) postoperatively ( P = .03). Patients in the LSNR group had a significantly higher percentage of sports participation than those in the HSNR group (91% vs 65%, P = .02) postoperatively. Conclusion: A lower signal intensity in the ATFL ligament based on preoperative MRI is associated with a better clinical outcome, particularly a higher rate of return to sport.

Fair evidence consistently supports open surgical treatment for chronic ankle instability: a systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. 254-269
Author(s):  
Chad Alexander Purcell ◽  
James Calder ◽  
Kentaro Matsui ◽  
Pontus Andersson ◽  
Jón Karlsson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Systematic Evaluation ◽  
Anatomical Reconstruction ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Reconstruction Technique ◽  
Operative Techniques ◽  
Level Of Evidence

ImportancePatients with chronic ankle instability (CAI) who have failed non-operative treatments are most commonly treated with open ankle repair or reconstruction of the anterior talofibular ligament and/or calcaneofibular ligament. Over 50 operative techniques have been described for the treatment of CAI. However, there is no current systematic evaluation of currently used open operative techniques for the treatment of CAI.Aim/ObjectiveThe primary objective of this study is to provide evidence-based treatment recommendations for CAI in adults based on a comprehensive systematic review of the literature.Evidence reviewThe literature review of PubMed, EMBASE, Cochrane and Web of Science databases was completed on 22 February 2017. Search terms included two concepts: lateral ligament of the ankle (patients) and open reconstructive or repair procedures (intervention). All published clinical studies with English translation were included. Biomechanical, cadaveric, review articles, minimally invasive procedures and arthroscopic procedures were excluded. Open operative procedures from included articles were classified as anatomical or non-anatomical and repair or reconstructive. Articles were then assigned a level of evidence (I-V) to denote quality of the research methods. Articles were reviewed collectively to provide a grade of recommendation (A-C or I) in support for or against the operative intervention in treatment of CAI.FindingsSeventy one of 1635 identified articles were included for review. There is fair evidence (Grade B) in support of anatomical repair, anatomical reconstruction and non-anatomical reconstruction procedures. There was insufficient evidence available to grade internal brace and non-anatomical repair procedures.Conclusions and relevanceAlthough only fair-quality evidence exists in support of open operative treatment of CAI, this systematic review helps reassure clinicians of their current practices. The literature reaffirms support for open anatomical repair and anatomical reconstruction technique for CAI.Level of evidenceLevel II, systematic review.

Arthroscopic-Assisted Versus All-Arthroscopic Ankle Stabilization Technique

2020 ◽  
Vol 41 (11) ◽  
pp. 1360-1367 ◽  
Author(s):  
Matteo Guelfi ◽  
Gustavo Araujo Nunes ◽  
Francesc Malagelada ◽  
Guillaume Cordier ◽  
Miki Dalmau-Pastor ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Clinical Results ◽  
Pain Scale ◽  
Chronic Ankle Instability ◽  
Percutaneous Technique ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Vas Score ◽  
The Mean

Background: Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely used to treat chronic lateral ankle instability. The aim of this study was to compare the clinical outcomes of these 2 arthroscopic stabilizing techniques. Methods: Thirty-nine consecutive patients were arthroscopically treated for chronic ankle instability by 2 different surgeons. The AB group comprised 20 patients with a mean age of 30.2 (range, 18-42) years and a mean follow-up of 19.6 (range, 12-28) months. The AI group comprised 19 patients with a mean age of 30.9 (range, 18-46) years and mean follow-up of 20.7 (range, 13-32) months. Functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog pain scale (VAS) were assessed pre- and postoperatively. Range of motion (ROM) and complications were recorded. Results: In both groups the AOFAS and VAS scores significantly improved compared with preoperative values ( P < .001) with no difference ( P > .1) between groups. In the AB group the mean AOFAS score improved from 67 (range, 44-87) to 92 (range, 76-100) and the mean VAS score from 6.4 (range, 3-10) to 1.2 (range, 0-3). In the AI group the mean AOFAS score changed from 60 (range, 32-87) to 93 (range, 76-100) and the mean VAS score from 6.1 (range, 4-10) to 0.8 (range, 0-3). At the final follow-up 8 complications (40%) were recorded in the AB group. In the AI group 1 complication (5.3%) was observed ( P < .05). Conclusion: Both the AB and AI techniques are suitable surgical options to treat chronic ankle instability providing excellent clinical results. However, the AB had a higher overall complication rate than the AI group, particularly involving a painful restriction of ankle plantarflexion and neuritis of the superficial peroneal nerve. Level of Evidence: Level III, retrospective comparative study.

Anatomical Reconstruction of the Lateral Ligaments of the Ankle with a Gracilis Autograft

2005 ◽  
Vol 33 (6) ◽  
pp. 814-823 ◽  
Author(s):  
Masato Takao ◽  
Kazunori Oae ◽  
Yuji Uchio ◽  
Mitsuo Ochi ◽  
Haruyasu Yamamoto
Keyword(s):  
Anatomical Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Stress Radiography ◽  
Lateral Instability ◽  
Calcaneofibular Ligament ◽  
Interference Fit ◽  
Lateral Ligaments ◽  
Anchoring System ◽  
The Mean ◽  
Talar Tilt

Background Few anatomical and minor invasive procedures have been reported for surgical reconstruction of the lateral ligaments to treat lateral instability of the ankle. Furthermore, there are no standards according to which ligaments should be reconstructed. Hypothesis A new technique for anatomically reconstructing the lateral ligaments of the ankle using an interference fit anchoring system and determining which ligaments need to be reconstructed according to the results of standard stress radiography of the talocrural and subtalar joints will be effective for treating lateral instability of the ankle. Study Design Case series; level of evidence, 4. Methods Twenty-one patients with lateral instability of the ankle underwent surgery using the proposed interference fit anchoring system. Standard stress radiographs of the subtalar joint were performed, and if the talocalcaneal angle was less than 10°, only the anterior talofibular ligament was reconstructed; if there was a 10° or greater opening of the talocalcaneal angle, both the anterior talofibular ligament and the calcaneofibular ligament were reconstructed. Results In the 17 patients who received only the anterior talofibular ligament reconstruction, the mean talar tilt angle on standard stress radiography of the talocrural joint was 14.5°± 1.7° before surgery and 2.6°± 0.8° 2 years after surgery (P <. 0001). For the 4 patients who had both the anterior talofibular ligament and calcaneofibular ligament reconstructed, the mean talar tilt angle was 16.5°± 1.5° before surgery and 3.0°± 0.5° 2 years after surgery (P =. 0015). The overall mean talocalcaneal angle on standard stress radiography of the subtalar joint was 11.3°± 1.4° before surgery and 3.5°± 0.8° 2 years after surgery (P =. 0060). Conclusion The proposed system has several advantages, including anatomical reconstruction with normal stability and range of motion restored, the need for only a small incision during the reconstruction, and sufficient strength at the tendon graft-bone tunnel junction, in comparison with the tension strength of the lateral ligaments of the ankle.

scholarly journals Anatomic reconstruction of anterior talofibular ligament with tibial tuberosity–patellar tendon autograft for chronic lateral ankle instability

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878087 ◽  
Author(s):  
Can Chen ◽  
Hongbin Lu ◽  
Jianzhong Hu ◽  
Xuqiang Qiu ◽  
Xiong Li ◽  
...  
Keyword(s):  
Bone Healing ◽  
Ankle Instability ◽  
Activity Level ◽  
Anatomic Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Talar Tilt ◽  
Tegner Activity Level

Introduction: Anatomic repair of the anterior talofibular ligament (ATFL) is challenging when the local ligamentous tissue is severely attenuated. Anatomic reconstruction of the ATFL with tibial tuberosity–patellar tendon (TT-PT) autograft is a feasible choice that can avoid the complicated tendon–bone healing and restore ankle stability. Materials and methods: From 2009 to 2015, 31 chronic lateral ankle instability (CLAI) patients (31 ankles), who had a serious injury on the ATFL only, were treated with anatomic reconstruction of ATFL with TT-PT. American orthopedic foot and ankle society ankle–hindfoot score (AHS), visual analog scale for pain score (VAS), Karlsson–Peterson score, Tegner activity level, and objective examination comprehending range of motion were used to evaluate the clinical outcomes before and after operation. Radiographically, talar tilt angles and anterior drawer were assessed in pre- and postoperative ankle stress views. Results: Among the 31 ankles, 17 ankles with single-bundle ATFL and 14 ankles with double-bundle ATFL were found at operation. At a mean follow-up of 42 months (24–82 months), all patients were satisfied with the procedure. Mean AHS significantly increased from 60.5 ± 8.2 to 93.5 ± 4.8. Mean Karlsson–Peterson score significantly increased from 55.2 ± 11.0 preoperatively to 91.2 ± 6.9 at final follow-up. Average VAS significantly decreased from 5.9 ± 1.6 preoperatively to 1.4 ± 1.0 at the latest follow-up. Mean Tegner activity level was 3.7 ± 0.9 before operation, compared with 7.0 ± 0.8 after operation. On stress radiographs, mean talar tilt angle was 17.0 ± 3.4° before operation and 3.8 ± 2.1° at the latest follow-up. In addition, mean anterior tibiotalar translation was 7.5 ± 2.2 mm before operation and 1.8 ± 1.1 mm at the latest follow-up. Conclusion: Anatomic reconstruction of the ATFL using a TT-PT autograft allows bone–bone healing in talus and tendon–tendon/periosteum healing in fibula rather than requiring tendon–bone healing, which is an alternative choice for treating CLAI caused by single ATFL insufficiency.

scholarly journals Lateral talocalcaneal ligament substitution for calcaneofibular ligament difficient chronic ankle lateral instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Chen Jiao
Keyword(s):  
Tilt Angle ◽  
Subtalar Joint ◽  
Ankle Instability ◽  
Stress Test ◽  
Lateral Ligament ◽  
Lateral Instability ◽  
Calcaneofibular Ligament ◽  
Anterior Translation ◽  
Negative Results ◽  
Talar Tilt

Category: Ankle, Hindfoot, Sports, Trauma Introduction/Purpose: Introduction: Treatment of chronic ankle lateral instability associated with defective calcaneofibular ligament via tendon reconstruction or artificial grafts has several disadvantages. The method of substitution with lateral talocalcaneal ligament has never been reported. Purpose: To investigate the role of lateral talocalcaneal ligament substitution for the treatment of chronic ankle lateral instability associated with defective calcaneofibular ligament. Methods: Repair of ankle lateral ligament was performed on 32 patients with chronic ankle instability. The mean age was 26.4±8.7 years. The calcaneofibular ligament was absent in all the patients and was confirmed surgically. The calcaneofibular ligament was repaired via transfer of talar insertion of the lateral talocalcaneal ligament. Patients were followed up for an average of 22.3±4.0 months. AOFAS, Mazur and Tegner scores, objective examinations (anterior drawer test and varus stress test) and re-injury were assessed before and after the operation. The anterior translation distance of the talus and the talar tilt angle were also measured. Results: In all the patients, postoperative AOFAS, Mazur and Tegner scores were significantly improved. Postoperative evaluation (drawer test and lateral stress test) yielded negative results. The anterior translation distance was reduced from 4.9±1.0 mm to 2.0±0.8 mm. The talar tilt angle was reduced from 12.7º±2.5º to 5.0º±1.4º. The average satisfaction score was 7.4. No subjective instability or re-injury, subtalar joint (tarsal sinus) pain or/and instability occurred. Conclusion: Lateral talocalcaneal ligament substitution was effective against chronic ankle lateral instability associated with the absence of calcaneofibular ligament, without any significant effect on subtalar joint clinically.

Activity Level and Function 2 Years After Anterior Talofibular Ligament Repair: A Comparison Between Arthroscopic Repair and Open Repair Procedures

2017 ◽  
Vol 45 (9) ◽  
pp. 2044-2051 ◽  
Author(s):  
Hong Li ◽  
Yinghui Hua ◽  
Hongyun Li ◽  
Kui Ma ◽  
Shengkun Li ◽  
...  
Keyword(s):  
Open Repair ◽  
Ankle Instability ◽  
Activity Level ◽  
Arthroscopic Repair ◽  
Open Group ◽  
Anterior Talofibular Ligament ◽  
Aofas Score ◽  
Lateral Ankle ◽  
Significant Difference

Background: The open modified Broström anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. Despite recent increases in publications regarding arthroscopic repair of the anterior talofibular ligament (ATFL) for treatment of chronic ankle instability, research is lacking that compares the functional outcomes between arthroscopic repair and open repair procedures for chronic ankle instability. Purpose: To compare function and activity level after arthroscopic repair versus open repair of the ATFL in patients with lateral ankle instability. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent arthroscopic or open surgical Broström repair of the ATFL between January 2012 and August 2014 were invited to participate in this study. All of the patients had consented for arthroscopic repair if feasible. In cases in which arthroscopic repair was impossible, the open modified Broström procedure was performed after arthroscopy. Patients accepted a systematic rehabilitation program postoperatively. American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner activity score were used to evaluate ankle function preoperatively and at a minimum follow-up of 2 years. Magnetic resonance imaging (MRI) was performed to evaluate the signal to noise ratio (SNR) of the repaired ATFL. Results: A total of 60 patients were included in this study. They were assigned to 1 of 2 groups according to their surgical procedure: 23 patients underwent arthroscopic repair (arthroscopic group) and 37 patients underwent open repair (open group). No patient in either group had ankle instability at follow-up postoperatively. After surgery, the AOFAS score ( P < .001), KAFS ( P < .001), and Tegner activity score ( P < .001) increased significantly in both groups. However, no significant difference was found in AOFAS score (93.3 ± 8.9 vs 92.4 ± 8.6; P = .7), KAFS (90.3 ± 12.5 vs 89.4 ± 10.6; P = .75), and Tegner score (5 ± 2 vs 5 ± 2; P = .61) between the arthroscopic group and the open group, respectively. As well, no significant difference was found in the mean SNR value of ATFL between the arthroscopic group and the open group (9.1 ± 2.7 vs 8.8 ± 2.3; P = .39, respectively). Conclusion: When compared with open lateral ankle repair, arthroscopic repair of lateral ankle ligament when feasible produced similarly favorable outcomes. Arthroscopic ATFL repair, as a minimally invasive technique, provided favorable outcomes.

scholarly journals The Augmentation Technique for Anatomical Reduction of Shortened Lateral Ligament Complex in Modified Broström Procedure

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0024
Author(s):  
Chan Kang ◽  
Gi Soo Lee ◽  
Jeong-kil Lee ◽  
Ki Jun Ahn ◽  
Sung Jin Hwang ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Clinical Findings ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Absorbable Suture ◽  
Anatomical Reduction ◽  
Calcaneofibular Ligament ◽  
Bone Tunnels ◽  
Modified Broström Procedure

Category: Ankle, Sports Introduction/Purpose: The modified Broström procedure(MBP) is clinically standard surgical treatment of lateral ankle instability with or without subfibular ossicle. But if there is a large ossicle or distal malposition of lateral ligament complex(LLC), it can result in a lack of remnant ligamentous tissue and leave gap that may not be approximated. Thus, we have proposed an augmentation technique for anatomical reduction of shortened LLC in MBP and evaluated radiologic and clinical findings. Methods: From December 2013 to February 2018, fifty two of fifty six patients who had shortened LLC treated with the augmentation technique with MBP using absorbable suture material. LLC(anterior talofibular ligament(ATFL) and calcaneofibular ligament(CFL)) was exposed after inferior extensor retinaculum(IER) was incised. Then, we identified shortened LLC. Then, we incised just distal part of connecting soft tissue of ATFL and CFL additionally for reduction to anatomic footprint. After confirmation of reduction, 4 or 5 bone tunnels were made and deep fiber of LLC was repaired tightly with foot in neutral dorsiflexion and 5° eversion by using horizontal mattress and simple stitch. Then, superficial fiber with capsule of LLC was repaired by priorly tied suture without cutting. Finally, IER was reinforced. Results: Mean AOFAS scores improved from 59.2 to 91.4 at final follow-up. Mean Karlsson scores also improved from 61.3 to 89.5 at final follow-up. Mean talar tilt angles were 13.4° preoperatively and 5.8° postoperatively. Mean anterior talar translations were 9.1 mm preoperatively and 5.7 mm postoperatively. There was significant improvement between preoperative & final follow- up in all parameters (all p < .05). During follow up, no clinical symptom like experience of instability or irritation of skin were encountered after surgery, and no patient underwent revision lateral ligament surgery. Conclusion: Augmentation technique of LLC flap in MBP enabled anatomical reduction of shortened LLC to footprint, and provided good clinical and radiographic outcomes. If further comparative and mechanical study is supported, this technique would be a good treatment option.

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